Rune Johansen

Education, sense of mastery and mental health: results from a nation wide health monitoring study in Norway

BackgroundEarlier studies have shown that people with low level of education have increased rates of mental health problems. The aim of the present study is to investigate the association between level of education and psychological distress, and to explore to which extent the association is mediated by sense of mastery, and social variables like social support, negative life events, household income, employment and marital status.MethodsThe data for the study were obtained from the Level of Living Survey conducted by Statistics Norway in 2002. Data on psychological distress and psychosocial variables were gathered by a self-administered questionnaire, whereas socio-demographic data were based on register statistics. Psychological distress was measured by Hopkins Symptom Checklist 25 items.ResultsThere was a significant association between low level of education and psychological distress in both genders, the association being strongest in women aged 55–67 years. Low level of education was also significantly associated with low sense of mastery, low social support, many negative life events (only in men), low household income and unemployment,. Sense of mastery emerged as a strong mediating variable between level of education and psychological distress, whereas the other variables played a minor role when adjusting for sense of mastery.ConclusionLow sense of mastery seems to account for much of the association between low educational level and psychological distress, and should be an important target in mental health promotion for groups with low level of education.

Pelvic girdle pain in pregnancy: the impact of parity

OBJECTIVE The purpose of this study was to estimate the association of parity with pelvic girdle syndrome (PGS; pain in anterior and bilateral posterior pelvis). STUDY DESIGN We included 75,939 pregnant women in the Norwegian Mother and Child Cohort Study. Data were obtained by self-administered questionnaires. RESULTS By pregnancy week 30, 15% of the women had developed PGS. Among first-time mothers, 11% of the women reported PGS, compared with 18% of the women with 1 previous delivery and 21% of women with 2 previous deliveries. The odds ratios for PGS of having had 1 or 2 previous deliveries were 1.9 (95% confidence interval [CI], 1.9-2.0) and 2.4 (95% CI, 2.3-2.6), respectively, after adjustment for other study factors. For PGS with severe pain, the corresponding odds ratios were 2.6 (95% CI, 2.3-2.9) and 3.8 (95% CI, 3.3-4.3). CONCLUSION The risk of the development of PGS increased with number of previous deliveries, which suggests that parity-related factors play a causal role.

Concerns for severity in priority setting in health care: A review of trade-off data in preference studies and implications for societal willingness to pay for a QALY

OBJECTIVE In a wide range of health care jurisdictions, to give priority to the severely ill over the less severely ill is important in decisions about resource allocation across patient groups. We summarise data on concerns for severity measured at a cardinal level in preference studies in various countries and show how the data may provide guidance for determining severity graded willingness to pay for a QALY. METHODS We review evidence in 15 articles published in peer reviewed journals in the time period 1978-2010, with reports from altogether 20 individual studies in 9 different countries. The studies all focus on the quality of life dimension of severity, i.e. utility losses on the 0-1 scale used in QALY-calculations. We report 116 individual observations of paired comparisons of utility improvements with different start levels. We argue that the strength of concerns observed on the quality of life dimension may be assumed to apply also to losses in length of life and thus to severity in terms of proportional shortfall of QALYs. By means of regression analyses we estimate a severity gradient in each study that suggests the span in societal willingness to pay for a QALY to people at high and low levels of severity respectively. RESULTS Concerns for severity show up quite strongly across countries, sample types and question framings, although the size of the severity gradient varies very much. Interested policy makers may hopefully find the central tendency in the results to be useful as an input to determining severity dependent willingness to pay for a QALY.

Socio-demographic, psychosocial and health characteristics of Norwegian senior centre users: A cross-sectional study

Aims: The senior centre is the only welfare service in Norwegian elder care serving both fit and less functional pensioners over 65 years. The aim of the study was to determine the socio-demographic, psychosocial and health characteristics of users of the senior centres in relation to non-users in order to find out who can benefit from the senior centre service. Methods: Data was collected from the Population Register for all persons living at home over 65 years in two municipal districts in Oslo. A random sample was drawn limited to 4,000 of the total number of residents over 65 years, 2,000 from each district. Questionnaires were sent by post. The response rate was 64% (n = 2,387). Psychological ailments were assessed using Hopkins Symptom Checklist-10 and social support with Oslo-3 Social Support Scale. Results: The percentage of users was 44 among the survey respondents. Age was the most significant variable explaining use of the senior centre; increased age led to greater use. Single women used the senior centre more than married women while single men used it less than married men. Other predictors for women included osteoporosis, memory impairment and participation/interest from others. Memory impairment was a predictor for men. Conclusions: High age and specific health problems led to increased use. Living alone predicted greater use among women but less use among men. The association with age could not be explained through socio-demographic, psychosocial or health variables.

A randomized controlled trial of a senior centre group programme for increasing social support and preventing depression in elderly people living at home in Norway

BackgroundLate-life depression is a common condition and a challenging public health problem. A lack of social support is strongly associated with psychological distress. Senior centres seem to be suitable arenas for community-based health promotion interventions, although few studies have addressed this subject. The objectives were to examine the effect of a preventive senior centre group programme consisting of weekly meetings, on social support, depression and quality of life.MethodsA questionnaire was sent to a random sample of 4,000 persons over 65 in Oslo, and a total of 2,387 completed questionnaires were obtained. These subjects served as a basis for recruitment of participants for a trial, with scores on HSCL-10 being used as a main inclusion criterion. A total of 138 persons were randomized into an intervention group (N = 77) and control group (N = 61). Final analyses included 92 persons. Social support (OSS-3), depression (BDI), life satisfaction and health were measured in interviews at baseline and after 12 months (at the end of the intervention programme). Perceptions of benefits from the intervention were also measured. Mean scores, SD, SE and CI were used to describe the changes in outcomes. Effect sizes were calculated based on the original scales and as Cohen’s d. Paired sample tests and ANOVA were used to test group differences.ResultsThere was an increase in social support in both groups, but greatest in the intervention group. The level of depression increased for both groups, but more so in the control than the intervention group. There was a decrease in life satisfaction, although the decrease was largest among controls. There were almost no differences in reported health between groups. However, effect sizes were small and differences were not statistically significant. In contrast, most of the participants said the intervention meant much to them and led to increased use of the centre.ConclusionsIn all probability, the intervention failed to meet optimistic targets, but possibly met quite modest ones. Since intention-to-treat analysis was not possible, we do not know the effect on the intervention group as a whole. A further evaluation of these programmes is necessary to expand the group programme. For the depressed, more specialized programmes to cope with depression may be a more appropriate intervention.Trial RegistrationDRKS00003120 on DRKS

Transforming EQ-5D utilities for use in cost–value analysis of health programs

Abstract In a number of jurisdictions there is increasing interest in incorporating concerns for fairness in models for economic evaluation of health interventions. Cost–value analysis is a name for evaluations with such a broader aim. The most widely held concern for fairness is a concern for the worse off, i.e. the idea that severity of illness should count in determining priorities. In economic evaluations of improvements in health-related quality of life this concern may be taken into account by replacing conventional health state utilities with societal values for health states that are characterised by strong upper end compression and decreasing marginal value of utility gains. We review evidence on the strength of concerns for the worse off—measured at the cardinal level—in 15 articles published in peer-reviewed journals in the time period 1978–2010, with reports from altogether 20 individual studies in nine different countries. We report 116 individual observations of paired comparisons of utility improvements with different start levels. Concerns for severity show up quite strongly across countries, sample types and question framings. By means of regression analyses we fit a societal value function to the data that has the property of decreasing marginal value of utility gains. Using the central tendency in the data we present two plausible transformations of EQ-5D utilities into societal values that reflect concerns for the worse off.

Observed trends in mental health: A strategy to adjust for nonresponse bias and demographic changes in survey data

Aims: To examine whether observed changes in self-reported psychological distress symptoms reflect true changes in psychological distress in the population, or more specifically, to present statistical methods to check for nonresponse bias and demographic changes. Methods: Lack of representativity, nonresponse bias and demographic changes were controlled for by weighing of data (sample-balancing or raking). Results: Controlling for age, gender and education, or holding the demographic structure constant over time, slightly weakened the decrease in psychological distress from 1998 to 2002, and left the changes in psychological distress from 2002 to 2008 almost unchanged. When the level of psychological distress was held constant across years in every subgroup defined by age, gender and education, in order to isolate the effects of changes in demography, the distress scores showed only minor variation across data collection occasions from 1998 to 2008. Conclusions: The observed modest decrease in psychological distress from 1998 to 2002 may partly be explained by selection and demographic changes, while this is not the case with the more pronounced changes from 2002 to 2008.